Contrast-enhanced cardiovascular magnetic resonance imaging of coronary vessel wall: state of art

Abstract

Coronary wall imaging by cardiovascular magnetic resonance (CMR) emerges as a promising method to detect vascular injury and remodeling directly within the coronary vascular wall. In this review, the current evidence on coronary wall enhancement using CMR is presented and summarized, with particular focus on its ability to detect inflammation in atherosclerosis, Takayasu's arteritis, acute coronary syndromes and immune-mediated inflammatory vasculitides. The authors review the possible mechanisms of coronary wall contrast enhancement on CMR and discuss the technical considerations and limitations. Lastly, the potential clinical applications and possibilities for future research are proposed.

Keywords::

• cardiovascular magnetic resonance
• coronary enhancement
• coronary wall imaging
• gadolinium contrast agent

Financial & competing interests disclosure

The authors would like to acknowledge funding sources from Department of Health via the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre (BRC) award to Guy's & St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital National Health Service Foundation Trust. C Lee was supported by a BRC Interdisciplinary PhD studentship award. R Hinojar was supported by the Spanish Society of Cardiology. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Coronary wall imaging by cardivascular magnetic resonance (CMR) with the use of gadolinium contrast agents can detect vascular injury and remodeling directly within the coronary vascular wall.

• CMR has the potential to recognize subclinical cardiovascular disease (CVD) and help identify individuals with increased risk of acute cardiac events, allowing early intervention.

• Increased coronary wall thickness has been demonstrated in patients with subclinical CVD, and positive remodeling was found in patients with angiographically confirmed nonsignificant CVD.

• CMR can identify regions of inflammation in conditions of atherosclerosis, Takayasu's arteritis, acute coronary syndromes and systematic vasculitides.

• Noncontrast T1-weighted imaging reveals that hyperintense signals are strongly associated with coronary remodeling and vulnerable carotid plaques that could cause coronary occlusion or thrombosis.

• Current limitations within CMR include motion compensation, spatial resolution and coverage of the coronary vessel.

• Tissue-specific contrast agents are currently being developed to expand the uses and applications of CMR.

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